| NPI | 1912693375 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AFZAL MODAK Board Member 857-416-9220 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103T00000X Psychologist | |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2026-05-29 |